Drug use during pregnancy poses substantial risks to the developing fetus. As drug use has become more prevalent in the general population, there has been growing concern about the number of neonates damaged by their mother's drug use. Legislation to address this problem has been introduced or enacted in a number of states. But such legislation can only have an impact on the problem to the degree that it affects the behavior of individual physicians, the professionals most likely to have non-adversarial contact with pregnant women. This proposal describes a study that will provide the first systematic national data about how physicians and the institutions in which they practice are responding to drug use among pregnant women. Specifically, the study aims to improve our understanding of the process by which physicians choose to detect drug exposure in pregnant women and newborns and what actions they take once drug exposure is detected. Other objectives are to clarify differences across hospitals and clinics in their response to prenatal substances exposure, to analyze how the legal environment affects the development and implementation of institutional drug detection policies, and to assess the extent to which physicians conform to legal mandates and hospital and clinic policies in their drug detection and reporting behavior. Our study will clarify policy issues in detecting and responding to prenatal substance use and should assist hospital, clinic, and health care policymakers in designing and implementing appropriate policies. Based on a conceptual model linking the legal environment, hospital and clinic characteristics and policies, and physician characteristics to physician drug detection and reporting behavior, we have designed a three-part study. We will first conduct an analysis in all states of legislative responses to drug use during pregnancy. We will field two mail surveys surveying hospital and clinic policies and physician behavior, one to physicians practicing obstetrics or neonatology, and one to key staff members in hospitals and clinics in which the sampled physicians practice. Finally, we will conduct a telephone survey in local Child Protective Agencies to clarify the role of local regulations on institutional policies and physician behavior.